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i �i i i i i i i � � t• � t• t� � l_� � <br /> Advanced <br /> CHAIN OF CUSTODY RECORD <br /> _�- GeoEnvironmental Inc. Date Page of <br /> 4005 North Wilson Way-Stockton California 95205-(209)467-1006-Fax(209)467-1118 <br /> Client Project Manager <br /> P�L1F� 0. C Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name AGE <br /> 1 fu 0 lLr�— r Client p <br /> PAC-6& C A <br /> Sample Location Date Time Sample Type Solid No of �R��� M Notes <br /> Number Description Water Air Conts <br /> Comp Grab <br /> I — M cw�liarit Well I ASS <br /> J fif r� + S <br /> \� 14 �r rr <br /> Nrwl+ O q ;zo x <br /> MWl-,5 a ),5 x <br /> mw -i+0 re q- ?� r(1 'OK <br /> Mu <br /> - <br /> MuJ I -2r. <br /> a 1l <br /> ` ♦a �I <br /> wo P3 - r25 X <br /> R7+ qu+s a +gnature ece+ve y +gnature �.� Nf� Dat rme <br /> l/Ill�1 7 i 0 G 'Zy'Q 7 <br /> Rehnquised by (Signatu ) Received by (Signature) Da etTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for lield analysis (Signature) Date rime <br /> Dispatched by (Signature) Date/Time ece+ve r Laborator by Datef ime <br /> ;7 a s <br /> Method of Shipment Laboratody Name <br /> CA J C 14 5-1If <br /> Special Instructions I hereby authorize the performance of the above indicated work <br /> U L le, <br />